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reception or transmission associated with the low altitudes
used by helicopters. In some instances, poor radio
communications were attributed to landing sites surrounded
by obstructions, usually the hospital or other
buildings:
✍ “After takeoff from local hospital, which is out of
radio contact with Tower but near their control zone,
(I attempted to contact Tower). By the time contact
was made, the airspace had been entered. A procedure
needs to be established for helicopter operators
to take off from areas within an ARSA where radio
contact is not possible until after takeoff.” (ACN 126017)
✍ “I was unable to contact Tower or Approach from
the hospital helipad. It [helipad] is down in a hole
surrounded by buildings. I departed without clearance
into ARSA/Control Zone and immediately contacted
Approach…He told me to stay clear of the
ARSA until radar contact (had been) established.
The problem is that I was already in the ARSA/Control
Zone on the pad at the hospital.” (ACN 142201)
14 Issue Number 6
Emergency 911
NMACs occurred frequently in airspace that requires
radio communication, specifically, in Class B, C, and D
airspace. However, many NMACs were also reported in
uncontrolled (Class G) airspace. Helicopters often fly in
uncontrolled airspace, usually at low altitude. Several
reporters indicated that due to frequent communication
problems and delays encountered in Class B, C, and D
airspace, they, and apparently many other small GA
aircraft (which were usually the other parties in the
reported NMACs), remained low-level in uncontrolled
airspace, not talking to ATC.
The NTSB found that in-flight encounters with weather
at low altitude were the single most common factor in
fatal EMS accidents, with most accidents occurring at
night. All 15 in-flight weather-related accidents occurred
at low-altitude and in uncontrolled airspace, and
10 of those occurred at cruise speed. In the ASRS study,
in-flight weather encounters were cited in 14 percent of
the reports. Pre-flight weather briefings had been obtained
in 80 percent of these incidents, but 75 percent of
the briefings did not match the actual weather conditions
the pilots encountered. The captain of a 2-pilot
crew, both IFR-rated and current, flying an IFR-certified
aircraft, described, the potential hazards of inaccurate
weather forecasts:
✍ “The biggest safety problem I see is lack of
accurate weather forecasting from a facility with
weather reporting. This is the third time I have been
inbound with a patient and have been caught by
unforecast weather conditions—not just a little off,
but all the way from VFR to low IFR. The last time
this happened they reported clear and 10 (miles
visibility) when in fact they were 300 (ft ceiling) and
1/2 (mile visibility), and went to 0-0 within an hour.
Unexpected IFR or IMC can cause confusion and
possibly even an accident with an experienced crew,
much less an inexperienced pilot in a VFR small
aircraft.” (ACN 138253)
Time Trap
Time pressure was cited as an frequent contributor to
incidents—the patient’s critical condition led to a sense
of urgency about the flight, which often resulted in
inadequate pre-flight planning. Reporters cited such
oversights as not stopping for refueling; failure to obtain
or review correct charts; overflying scheduled aircraft
maintenance; inadequate or less-than-thorough
weather briefings; and inadequate evaluation of weather
briefings preceding the go/no-go decision. Patient criticality
was reported as a major contributor to time
pressure in 44 percent of the reports. Time pressure
associated with the patient’s condition seemed to be
present regardless of whether the patient was already
on-board the aircraft or the pilot was en-route for
patient pick-up.
Recommendations have been made to try to isolate the
EMS pilot from the overall medical situation and the
patient’s condition. However, the pilot is well-aware
that his or her services would not have been requested
unless a serious medical situation existed. It is a normal
human emotion to respond to an emergency. Given the
sense of urgency that seems to be inherent in an EMS
operation, and the potential for both verbal and nonverbal
expressions of the necessity for speed, that attempt
at isolation may be unrealistic or impossible to
achieve. In numerous reports of airspace violations and
inadvertent IMC encounters, pilots belatedly recognized
their lack of separation from the medical circumstances.
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